New Client Request Form
Thank you for your interest in personalized bodywork. Each session is tailored to your unique goals, whether you are seeking relief, recovery, or deep relaxation. Please complete the form below so I can learn more about your needs and reach out with availability.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Massage Goals & Intentions
*
Stress Relief (Nervous System Reset, Relaxation, Scalp and Facial Massage)
Pain or Tension Relief (Past Injury, Chronic Pain, etc.)
Athletic Recovery (Stretching, Cupping, Deep Tissue)
Not sure yet- open to recommendations
If seeking pain relief, out of 5, what is your current pain level?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Are you pregnant? If so, how far along are you?
*
Not Pregnant
1st Trimester
2nd Trimester
3rd Trimester
I am interested in all of the enhancements below (all included in pricing)
*
Hot stones
Cupping
Near-infrared & red light therapy
Aromatherapy
Heated table
Hot towels
Stretching
Facial cupping & acupressure
Deep tissue
Scalp massage
What session duration are you interested in booking?
*
Please Select
60 minute
90 minute
120 minute
not sure yet
How did you hear about my services?
*
Instagram
Google
Personal Recommendation
Facebook
Other
Will you be using an HSA or FSA to fund your session?
*
Yes, HSA
Yes, FSA
No
Not sure what that is
Are you interested in hearing more about memberships and continued care?
Yes!
Not at this time.
Submit
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